Term
| What are the initial labs that should be performed for status epilepticus? |
|
Definition
CBC, chem, Mg, Ca, AED levels, toxicology, alcohol. Perform fingerstick
50cc of 50% dextrose is hypoglycemic
100mg of thiamine |
|
|
Term
| After ABCs and labs, what is the initial management of SE? |
|
Definition
IV lorazepam (4mg over 2 minutes), repeat if needed at 8-10 minutes
or
IV diazepam (10mg over 2 minutes), repeat if need at 3-5 minutes |
|
|
Term
| If SE persists after 10 minutes, what is the appropriate management? What are some of the pharmacological benefits of this agent? |
|
Definition
- Fosphenytoin IV 150 mg/min (dose at 20 mg/kg)
- Fast acting (similar to phenytoin) but with decreased bradyarrythmia and hypertension (still important to monitor with EKG and blood cuff)
|
|
|
Term
| After 20 minutes, what is appropriate management of SE? |
|
Definition
| Two additional administrations of fosphenytoin at 5 mg/kg |
|
|
Term
| After 30+ minutes, what is the appropriate management of status? |
|
Definition
- IV valproate (25 mg/kg @ 3 mg/kg/min)
- Alternatively 20 mg/kg of IV phenobarbital (intubation necessary due to possible respiratory arrest)
- If persisting, consider continuous infusion of either:
- Midazolam
- Pentobarbital
- Propofol
|
|
|
Term
| What are the pathognomonic characteristics of absence seizures? |
|
Definition
| 3hz wave pattern on EEG, induced by hyperventilation |
|
|
Term
| What are the metabolic disorders associated with seizures? |
|
Definition
- Hypoglycemia
- Hyperglycemia
- Hypoxia
- Hypocalcemia
- Hyponatremia
- Hypomagnesemia
- Uremia
- Rarely ammonia (hepatic encephalopathy)
|
|
|
Term
| Which tumors often present with seizures? |
|
Definition
| Meningioma, glioma, metastatic tumors |
|
|
Term
| What are some of the congenital causes of seizures? |
|
Definition
- Cortical dysplasia / dysgenesis (heterotopia, microgyria, pachygyria)
- Vascular malformation (Sturge-Weber)
- Prenatal injury (antenatal stroke, TORCH)
|
|
|
Term
| A 20 year-old female presents with complaints of strange recurring episodes. During these periods, she experiences sensations of deja vu and a distinct fishy odor. Her family reports a recent history of mood change, including irritability and paranoia. What is the most likely syndrome? How else can it present? What structural damage coexists with this condition? |
|
Definition
- Temporal lobe epilepsy
- Altered consciousness (complex partial) or tonic-clonic (secondary generalized)
- Hippocampal sclerosis
|
|
|
Term
| What seizure-inducing disorder is associated with cafe-au-lait spots? Hypopigmented macules? Port-wine stain? |
|
Definition
- NF-1 leading to astrocytoma or optic glioma (also Von Hippels and tuberous sclerosis)
- Tuberous sclerosis leading to giant cell astrocytoma or subependymal nodule
- Sturge-Weber leading to calcification
|
|
|
Term
| What are the first choice drugs for partial seizures? Absence? Generalized tonic-clonic? Myoclonic/tonic/atonic? |
|
Definition
- Carbamazepine, lamotrigine, oxcarbazepine, phenyoin, topiramate, valproic acid
- Ethosuximide, lamotrigine, valproic acid
- Carbamazepine, phenytoin, topiramate, valproic acid
- Valproic
|
|
|
Term
| What is the therapeutic range of phenytoin? |
|
Definition
|
|
Term
| What is the therapeutic range for phenobarbital? |
|
Definition
|
|
Term
What is the therapeutic range for carbamazepine?
|
|
Definition
|
|
Term
What is the therapeutic range for valpoate?
|
|
Definition
|
|
Term
| What are the major side effects of phenytoin? |
|
Definition
- Dose dependent
- Induces seizures at high levels
- Nystagmus
- Megaloblastic anemia (folate deficienc)
- Gingival hyperplasia, peripheral neuropathy, SLE, osteoporosis
|
|
|
Term
| What are the major side effects of carbamazapine? |
|
Definition
- Leukopenia and Steven-JOhnsons (particularly in asians)
- Hyponatremia, SLE, dyskensias
|
|
|
Term
| What are the major side effects of valproate? |
|
Definition
- Resting tremor and thrombocytopenia, with abnormal clotting
- Alopecia and weight gain
|
|
|
Term
| What are the major side effects of phenobarbital? |
|
Definition
- Sedation, depression / psychosis in elderly
- Vitamin D deficiency (hypercholestrolemia, osteoporosis)
- Fibromas and contractures
|
|
|
Term
| Why should lamotrigine be titrated up slowly? |
|
Definition
| Can induce skin rash (or even Steven-Johnson's) |
|
|
Term
| What are some of the side effects of topiramate? In addition to its use as an AED, what other mechanism of action does it possess? Why should one "start low, go up slow" when administering it? |
|
Definition
- Kidney stone formation and loss of appetite
- Carbonic anhydrase inhibitor (used for pseudotumor cerebri)
- Cognitive effects if increased to rapidly
|
|
|
Term
| What are the benefits of levetiracetam? What are some concerns when giving it? |
|
Definition
- Decreased side effects, with no drug-drug interaction
- Renally metabolized (adjust for renally impaired or elderly)
|
|
|
Term
| A 24-year old patient presents with several recurring episodes of "motionless stare", accompanied by lip smacking and fumbling. There is generally a loss of consciousness during these episodes. They are preceded with a strange abdominal sensation, and followed by confusion and headaches. What is this syndrome called? How does it present on EEG and MRI? |
|
Definition
- Mesial temporal sclerosis
- Anterior or mid-temporal spikes; atrophic hippocampus with enlarged temporal horn of the lateral ventricle
|
|
|
Term
| A 14 year-old female patient presents with repeated episodes of strange motor symptoms, described as spastic jerking of the neck and extensors. These generally occur symmetrically, and often present in the morning. On top of these symptoms, the patient has also been diagnosed with general tonic-clonic seizures and absence seizures. What is the most likely syndrome? What can induce the symptoms? How is the prognosis? |
|
Definition
- Juvenile Myoclonic Epilepsy
- Fatigue/lack of sleep, alcohol, fasting, menstruation, emotional stress
- Persists into adulthood, but generally good response to AEDs
|
|
|
Term
| A 6 year-old patient presents to your office. The mom has noticed severe twitching on half of his face while he is awake, and gagging while asleep. There have also been some scary moments when the patient had general convulsions during sleep. What is the most likely diagnosis? |
|
Definition
| Benign Rolandic epilepsy; generally remits by late adolescence |
|
|
Term
| An infant presents with a history of severe spasms and failure to meet major developmental milestones. These spasms are characterized by sudden flexion of neck and for extremities. An EEG performed in between episodes shows high amplitude slow waves with disorganized background. What is the most likely diagnosis and treatment? |
|
Definition
- Infantile spasms / West syndrome
- ACTH (vigabatrin if caused by Tuberous sclerosis)
|
|
|
Term
| A 4 year-old patient comes in with signs of epilepsy. They have a previous history of infantile spasms, but are now presenting with a variety of differing seizures. EEG shows a slow-spike-and-wave pattern at 1.5-2.5 Hz. What is the most likely condition? |
|
Definition
| Lennox Gastaut syndrome (poor prognosis) |
|
|
